低浓度枸橼酸钠局部抗凝血液透析在高危出血尿毒症患者中应用的研究

Application of regional citrate anticoagulation for hemodialysis with low-density sodium citrate in high risk uremic patients

目的评价低浓度(2.5%)枸橼酸钠局部抗凝血液透析(RCAHD)在高危出血尿毒症患者中应用的效果及安全性。方法采用自身对照将18例高危出血尿毒症患者按治疗单、双日设为观察组与对照组。观察组采用2.5%枸橼酸钠RCAHD36例次,对照组采用无肝素0.9%氯化钠注射液冲洗法HD22例次,观察两组患者在血液透析过程中出、凝血情况,不良反应;透析充分性,活化凝血时间,血气,肾功能与电解质变化。结果观察组静脉壶凝血、透析器血室容积优于对照组(χ2分别=36.04、4.56,P均<0.05),治疗时间、实际超滤量、透析充分性均优于对照组(t分别=2.73、3.08、2.45,P均<0.05);观察组透析管路静脉端各时间点较动脉端相应时间点活化凝血时间明显延长(t=3.26,P<0.05);观察组静脉端血清钙在透析1h、2h、4h时与动脉端比较明显降低(t=3.12,P<0.05);透析1h、2h、4h及结束时,动脉端血pH、剩余碱与透析前比较明显升高(t分别=2.53、2.78,P均<0.05)。结论低浓度枸橼酸钠局部抗凝效果确切,透析充分,不增加出血风险,是高危出血尿毒症患者行HD安全有效的抗凝方法。

Objective To evaluate the effect and safety of low-density sodium citrate （2.5%） for hemodialysis in the high risk uremia patients. Methods Eighteen uremia patients were divided into experimental and comparative group. In experimental group, 2.5% RCAHD were used for 36 times while 0.9% sodium chloride was used for 22 times in comparative group. Clot blood, harmful reactions, abundance of hemodialysis, activated clotting time （ACT）, vigor, kidney function and the change of electrolysis were analyzed. Results There were significant differences between the experimental and comparative group in vein clotting and total cell volume（TCV） （X2=4.56,36.04,P〈0.05）; there were significant differences between the experimental and comparative group in the treatment time, actual ultra filtration and the abundance of hemodialysis 0=2.73,3.08,2.45,P〈0.05）.The vein hemodialysis time of ACT in the experimental group was longer than that of the comparative group （t=3.26,P〈0.05）. The vein serum calcium in the experimental group was lower than the artery serum calcium after one two and four hours of hemodialysis （t=-3.12,P〈 0.05）. After one two and four hours and end, the artery pH, BE was higher than that before hemodialysis（t=2.53, 2.78, P〈0.05）.Conclusion The effect of RCAHD is good and the hemodialysis is abundant. It will not enhance the risk of patients. So RCAHD is safe and effective for high risk uremia patients.